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Thursday, 8 February 2007
Page: 8


Ms HALL (4:12 PM) —I would, firstly, like to concentrate on a statement made by the member for Dobell, the previous speaker in the debate on the Private Health Insurance Bill 2006 and related bills. I believe the member for Dobell was very loose with the truth when he said that the shadow minister for health does not support the 30 per cent rebate. I refer the House to the statement the shadow minister for health made in this debate, where she said:

Labor has supported the 30 per cent rebate on private health insurance at the last two elections and will support it again. Labor accepts and understands that many Australians have come to rely on this support and will not take it away.

I think that the member for Dobell stands condemned for being so loose with the truth.

I would also like to bring to the attention of the House that the same speaker, the member for Dobell, and the Minister for Health and Ageing in question time today really substantiated comments about this being a blame game and really showed that the government fail to take responsibility for any problems within the health system or any problems relating to private health and blame the state government or whoever it takes their fancy to blame for any problems that exist. During my contribution to this debate, I shall be referring to some of the issues that were raised.

A considerable part of the legislation before us today was alluded to or committed to in the budget in the middle of last year. The broader care component of this legislation was outlined in the budget and the out-of-hospital care component of this legislation was part of the budget. During the House of Representatives Standing Committee on Health and Ageing inquiry, we took evidence from the Private Health Insurance Association. The Private Health Insurance Association highlighted the need for a change to the legislation that would allow them to provide services such as chemotherapy, dialysis and mental health treatment outside of hospitals—that is, out-of-hospital care. This legislation allows that to happen. They also argued strongly to be allowed to fund wellness programs such as the Quit program—quitting smoking—weight loss programs and other programs that they believe would contribute to the overall long-term improvement in health care of their members.

I support the provision of these services. I support the provision of the broader care program that is highlighted in this legislation, but, in doing so, I have to raise some concerns. Firstly, the private health insurance industry has said that the price of private health insurance premiums will not increase. There has been only one way that private health insurance premiums have gone—that is, up. They have gone up at a faster rate than the CPI. When the lifetime private health coverage and other initiatives of this government—the 30 per cent rebate—were introduced, we were told that this would see that private health insurance premiums would go down, but that has not been the case, and I am concerned that, yet again, we will find ourselves in the same situation.

Another issue is equity. A two-tiered system will develop because of this. People in private health will be able to enjoy this out-of-hospital care—and I think that is excellent—but when the government are negotiating Commonwealth healthcare agreements they should be very mindful of the fact that it should also benefit public patients, and the agreements should look at funding the same services for people who utilise the public system.

Under this government, we have had a definite move to a two-tiered system. I argue strongly that this is the government’s chance to demonstrate to the Australian people that it is prepared to ensure that, no matter whether they have private health insurance or whether they are a public patient in a hospital, people are able to access the same level of care. They should not be treated as second-class citizens. That is the challenge for the government. It has to ensure that all Australians get the same care that will be available to people with private health insurance.

The other issue that concerns me—and I note that the AMA has raised this concern—is that this could be a step towards managed care. I asked the private health insurance industry representatives when they gave evidence to the House of Representatives Standing Committee on Health and Ageing whether that was the case. I am not convinced that we will not end up with managed care. I really believe that decisions about the best treatment for a patient should not be made by a health insurance company but by the treating doctor. My word of caution is that, whatever happens, we should ensure that it is the doctor who makes the decision about the best kind of treatment for a person.

The downside of this is that a very large amount of money—$55 million—has been allocated by the government to advertise these changes. I do not think that $55 million of health money being spent on advertising is an effective use of public funds, and I am sure that the people I represent in this parliament would like to see that money go towards the direct delivery of health services. I think the government really needs to revisit that.

I would like to now move to the changes to Lifetime Health Cover. Currently, if a person takes out health insurance after they reach the age of 30, the amount of their premium increases by two per cent for every year they are over the age of 30. This legislation will allow a person who has been a member of a private health fund for 10 years to be no longer subject to that loading. I think that is a positive move and, I might add, I referred a submission from a constituent in the Shortland electorate to the health and ageing committee that recommended that that should be the case. The person had withdrawn from private health insurance when they lost their job, and they were now more financial. They would have liked to have rejoined but could see that they would get no reward for being a member over a long period of time. So that move is a positive initiative.

The other initiative that I think is quite positive in this legislation is that private health insurance funds provide information on standard products. That will enable people to be aware of the health insurance product they are buying and be able to compare it with the products being offered by other funds. They are good changes.

I want to spend the remainder of my contribution to this debate highlighting some of the issues relating to private health insurance and some of the aspects in this legislation that were raised in The blame game, the report on the committee’s inquiry into health funding in Australia. One of the concerns that was raised in relation to the broad cover that we are talking about—it is included in this legislation; I refer the House to paragraph 8.44—was the potential for the quality of care to be compromised if the care is moved outside the hospital. I do not think the quality of care that people will receive has been ensured in this legislation. I note that the shadow minister included it in her amendments but I think it is one issue that the government needs to address and look at very carefully. If patients are receiving substandard care outside hospital and proper controls are not in place then it is only those people who have health insurance that will be disadvantaged by the changes that are included in this legislation.

There are two issues that I am very disappointed that the government has not addressed in this report. One of those is the issue of informed consent. That was one of the issues that was raised a number of times with the committee—I refer you to 8.62 in the report, which highlights a contribution from the Department of Health and Ageing. It said that 44 per cent of in-hospital episodes in private hospitals for patients covered by private health insurance involved a gap and 21 per cent of in-hospital episodes involved a gap and a lack of informed consent. I think that is very important. If a person knows they have to pay a gap they can budget for it, but if they pay a gap and they do not know they are going to incur a debt it can create extreme financial pressure for them.

I have a submission that was given to the committee. It is from a constituent in the Shortland electorate, and this constituent, Duncan Brown—I know he will not mind me mentioning his name; he is in the Hansard and the records of the committee—raised his own particular case with the committee. He had a serious heart condition and chose to have private health insurance. He knew he would incur a gap. He was a patient in St Vincent’s Private Hospital in Sydney. He had state-of-the-art surgery and was very pleased with it.

He thought he would incur a debt of around $5,000. When he received his account the debt was $6,420 but he withdrew the extra money from his pension savings. Some months later he received a further bill for $1,800—I think that was the amount—from the anaesthetist and he ended up with a gap all up of $8,264.35. So he incurred a much greater cost—$3,264 more than he had budgeted for. This was quite a problem for him.

When the health ombudsman gave evidence to the committee he also highlighted the issue of informed financial consent. He referred to a case where a patient believed that they would have a gap of $250. They ended up with the $250 gap but received another bill from the anaesthetist that led to them incurring a significant gap payment that they had not been aware of.

Recommendation 22 of the report The blame game is that private health insurance legislation be amended with a single coordinating doctor to get around the issue of informed financial consent. It is very important that people are aware of the debt they will incur when they have an episode in hospital. Whilst the government has addressed one issue that was supported by the committee, broader health cover, it has ignored the issue of informed financial consent—an issue, I might add, that members on both sides of this House are constantly contacted by their constituents about. I feel that it is very important that the government looks to that matter and deals with it.

The other issue I quickly want to touch on was one raised by the ombudsman and highlighted in the report—the issue of fund transfer. There was some concern expressed to the committee that doctors recommend to patients that they transfer from one fund to another. The ombudsman points out that careful consideration needs to be given to the ethical and legal implications of endorsement by a doctor of a commercial product or services. The AMA advises against public endorsement and it also advises doctors against public endorsement of advertisements relating to health matters.

Once again, there was a recommendation in the report that the government address that. It has not been included in this legislation. I think the legislation before us is much weaker because it has not been included. The government would have been much better putting its mind towards developing some changes and amendments to the legislation to deal with that. It would have been much more productive for the Australian population if they had legislation that was going to deliver them informed financial consent rather than the government investing $55 million of health care money on an advertising campaign. I do not think that is in the interests of the Australian people; I think Australians would benefit more by the government amending this legislation to include those matters that I have raised before the House today. I realise that the debate is about to end—it probably has ended.